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Gastrointestinal > Stomach > Flashcards

Flashcards in Stomach Deck (62):
1

Give a differential for thickened, lobular folds in the body and antrum

Gastritis - H. pylori
Zollinger-Ellison
Lymphoma

2

Which ulcer is h. pylori more associated with?

Duodenal (90%) vs Gastric (70%)

3

Give a differential for small, round, filling defects with a small central collection of barium

Erosive (varioloform) gastritis
Barium precipitate (dont have mound of edema)
Crohns (will have other lesions)

4

What are the features of a benign gastric ulcer

Round or oval crater
Folds that CROSS the mound of surrounding edema
Symmetric and smooth filling defect surrounding the crater
Extension of the ulcer beyond the normal gastric lumen contour
Smooth and symmetric radiating gastric folds

5

Where do most benign ulcers occur

Along the lesser curvature or posterior wall of the antrum/body

6

Benign ulcers along the greater curvature are associated with what

aspirin coated medication

7

What is a hamptons line

Line of nonulcerated acid-resistant mucosa around the ulcer crater - BENIGN feature

8

How does a healing ulcer presents? When do they start to heal?

Linear configuration
Can split into 2 smaller crates as reepitheliazation occurs
8 weeks

9

What are the signs of a healed ulcer?

Radiating folds with retraction indicates fibrosis
Area gastricae in the scarred region

10

What is a benign sump ulcer? Differentiate between an intramural diverticulum.

An ulcer crater in the dependent stomach along the distal greater curvature (like a sump collection)

Usually due to medication

Smooth surfaced and tapers gradually. Surrounding edema has abrupt margins

Diverticulum will change shape with peristalsis and not have surrounding edema

11

What size is a giant ulcer? Is there any prognostic indication based on size? multiplicity?

>3cm
Size doesnt matter
Multiple favor benign cause, but should be evaluated individually

12

What are the major complications of gastric ulcers?

Bleeding - most common
Perforation
Obstruction
Perforation with fistula formation

13

What is the most common cause of gastrocolic fistulas?

Primary carcinoma of stomach or colon

14

Differentail for enlarged rugal folds, hypersecretion, peptic ulcers, and thickened folds in the proximal small bowel

Zollinger - ellison
Lymphoma
Gastric Ca - focal mass or narrowing
Menetrier - proximal stomach only

15

What is zollinger - ellison syndrome?

Pathology
How many are malignant?
What associated sydrome? How many?

Symptoms

Diagnostic test?

Gastric secreting islet cell neoplasm

Marked hypersecretion of HCl with peptic ulcer disease

50% are malignant
1/4 have MEN1 (parathyroid, pitiutary, pheochromocytoma)

Intracatble peptic ulcer disease with malabsorption

Paradoxical increase in gastrin with secretin injection

16

What is an aphthous ulcer? What is it seen in ?

Central ulceration with surrounding mound of edema

Crohns (will have other GI involvement)
Erosive gastritis

17

Markedly enlarged gastric folds in the proximal stomach?

Menetrier disease (hypertrophic gastropathy)

Hyperplasia of surface epithelial cells with abundant mucus cells. Results in achlorhydria due to replacement of parietal cells.

Folds will be organized and follow distribution of normal rugae (unlike lymphomatous proliferation)

18

What is a differentiating feature between hyperplastic and adenomatous gastric polyps?

What do multiple small polyps designate?

Hyperplastic - multiple, 1cm, usually carry malignant potential if >2cm

Innumerable - FAP

19

What types of gastric polyp is seen in FAP? Duodenal polyp?

Gastric - hyperplastic
Duodenal - adenomatous

20

What are the two main variations of FAP?

Gardner - FAP, desmoid tumors, osteoma, epidermoid cysts, papillary thyroid

Turcot - FAP, CNS tumor (gliomas, medulloblastomas)

21

What type of polyp is seen in FAP associated symdromes?

The other polyposis syndromes? (canada chronkite, peutz jeugher)

Hyperplastic

Hamartomas

22

What are the following syndromes?

Mucocutaneous pigmentation, GI malignancy, gynecologic malignancy

Mucocutaneous lesions, thyroid abnormalities, breast abnormalities

Stomach, small bowel, colon, ectodermal changes (skin, hiar, nails)

Peutz-Jeugher

Cowden

Cronkhite-Canada

23

Differential for well demarcated, smooth surfaced mass

Submucosal tumor

GIST (most common submucosal gastric tumpor)
Lipoma
Fibroma
Carcinoid
Neurogenic tumors, leiomyoma

24

What characteristics help differentiate a malignant GIST?

Size - >10cm
Irregular shape
Central necrosis

25

Differentiate a lipoma/GIST from an ectopic pancreatic rest

EPR will have a central ulceration and be near the antrum

26

What are characteristics of malignant gastric ulcer?

Fold clubbing, tapering, interruption, and fusion

Nodular adjacent tissue
Abrupt transition between the surrounding tissue and normal gastric tissue
Crater doesnt project beyond expected location of the gastric wall
Radiating folds stop at the crater edge and do not reach the crater edge
Carter is wider than deep

27

What is the carmen meniscus sign?

Seen when a malignant ulcer straddles the lesser curvature and compression aposes both surfaces of the surrounding tumor.

Appears as a crescent (half moon) on the lesser curvature with nodular tumor surrounding the periphery

28

What are the risk factors for gastric carcinoma

High starch diets
Polycyclic hydrocarbons (smoked meats)
Nitrosamines (processed meats)

29

Nodular appearance of the gastric serosa indicates what

Extension to the omentum

30

What are the common nodal groups for gastric mets

lymphomaspecifically?

Parapancreatic, paraaortic, middle colic

Gastrohepatic (lesser and greater curvature)

31

Where are 4 common spots for peritoneal metastases

Pouch of douglas
Sigmoid mesocolon
Right paracoloic gutter
Small bowel mesentery

32

At what level does lymphadenopathy indicate lymphoma vs gastric carcinoma?

At or below the level of the renal pedicles

33

What is the most common nonnodal site for nonhodgkins lymphoma

Stomach

34

What are features that suggest gastric lymphoma over adenocarcinoma?

Multiplicity, submucosal, extesnion beyond the pylorus

35

What is the differential for a solitary ulcerated lesion in the stomach

GIST
Primary gastric adenocarcinoma
lymphoma
ectopic pancreatic rest
Metastatic melanoma

36

What is a bezoar

Concretions of ingested material

Mottled soft tissue mass which is not attached to a gastric wall and through which is interspersed barium

Differentiated by its free movement

37

What is the incidence of ectopic pancreatic rests?

How do the appear radiographically

14%

Umbilicated submucosal nodule with the distal stomach usually

38

What are two causes of gastric varices

Portal venous hypertension

Splenic vein occlusion

39

How can one differentiate splenic vein occlusion as the source of varices from portal hypertension?

Splenic vein occlusion will not have esophageal varices, because of the secondary drainage via short gastric veins. Blood will flow to thw gastric fundus plexus and return to the portal system via the left gastric

40

Smooth, symmetric tapering at the antrum suggests what 4 dx? "Rams horn" appearance

Scarring from PUD
Granulomatous disease - distal (antrum) stomach most commonly affected
Scirrhous carcinoma
Metastatic breast cancer (Scirrhous appearance)

41

Nodularity and narrowing of the distal stomach and nodular fold thickening in the small bowel suggests what?

Where is the best site for biopsy? Tx?

Eosinophlic gastroenteritis (Nodular appearance separates from other granulomatous diseases)

Antrum

Self limited

42

What is the differential for a featureless stomach?

Overdistension

Atrophic gastritis

43

What are the two types of atrophic gastritis?

Type A - autoimmune antibodies to parietal cells and intrinsic factor. usually affects the BODY and FUNDUS

Type B - H. pylori associated. usually affects the ANTRUM

44

Differentiate caustic stricture of the antrum from granulomatous disease.

Caustic will have a classic history of ingestion, lesions in the esophagus and duodenum, and be ABRUPT in margination

Granulomatous will be a smooth tapered narrowing.

45

What is a linitis plastica appearance? What is the pathology?

"Leather bottle" appearance, carcinomatous spread along the submucosa causes a desmoplastic reaction that looks like a narrowed water bottle.

46

What are the types of gastric adenocarcinoma? What is the difference?

Polypoid and ulcerative do not enhance

Scirrhous will enhance and is submucosal

47

What 4 entities can have a "linitis plastica" appearance?

Scirrhous gastric cancer
Metastatic BREAST cancer
Omental mets (lymphoma) alont the gastrocolic ligament
Granulomatous disease

48

What is a marginal/stomal ulcer? Where do they usually occur?

Perianastomotic ulcer developing after a gastorenterostomy.

Usually occur on the EFFERENT limb of the JEJUNUM, within 2 cm of the stoma.

49

Marginal ulcers should raise suspicion of what conditions

Incomplete vagotomy, retained gastric antrum (parietal cells), zollinger-ellison, hypercalcemia, smoking

50

What is afferent loop syndrome?

Dilated, fluid filled duodenum s/p billroth II

51

What is blind loop syndrome?

A sequelae of afferent loop syndrome, whereby obstruction leads to bacterial overgrowth, vitamin B12 deficiency, and megaloblastic anemia

52

What is a blown duodenal stump?

Breakdown or leakage of the afferent limb (duodenum) after a billroth II

53

Which limb more commonly intussucepts after billroth II?

Jejunal (efferent)

54

What are the two appearances of postgastrectomy carcinoma?

Constricting and diffuse, which will cause narrowing

Polypoid

55

What is the timeline for gastric remnant carcinoma vs primary tumor appearance

Remnant - several months

Primary - 20-30years

56

What are the 3 steps in a traditional gastric bypass

1. creation of a small gastric pouch
2. jejunogastrostomy using a jejunal roux limb with a small gastric stomal opening
3. Side-to-side anastamosis of the excluded limb with the antegrade jejunal roux limb

57

What is the timeline and percentage of anastomotic leak postop gastric bypass

1-2 days, 1-5%

58

What is the incidence of internal hernia after gastric bypass? What are the imaging findings? Where is the most common defect?

2%

Clustered bowel loops, visible entrance and exit limbs, displaced jejunojejunal suture line, change in bowel configuration, stasis within herniated loops

Transverse mesocolon

59

Where do most gastric diverticula arise?

Posterior surface of fundus near GE junction

Will contain mucosal folds and change with peristalsis

60

Differentiate gastric ulcer and partial diverticulum

Diverticulum will change with peristalsis, usually located along greater curvature

61

Asymptomatic intramural pneumatosis is seen with what

Corticosteroid use

62

What are the two gastric volvuli? How do they differ? Which on is worse?

Organoaxial - along longitudinal axis of stomach, more common. Associated with hiatal hernia. Greater curvature is located superior and GE junction is in normal location

Mesenteroaxial - folds stomach in half, GE junction is displaced superiorly. More prone to ischemia.